Abstract WP23: Hemorrhagic Transformation Following Anticoagulation in Victims of Acute Ischemic Stroke Secondary to Intra-Cardiac Thrombi

Introduction: Hemorrhagic transformation (HT) following acute ischemic stroke (AIS) is a common consideration especially when therapeutic anticoagulation is indicated in cases such as left ventricular or left atrial appendage thrombi. Although there have been multiple studies investigating the safe timing of anticoagulation initiation following AIS in patients with atrial fibrillation, the results varied. Evaluating the infarct volume and correlating it to time of anticoagulation initiation and HT can be detrimental to patient safety.

Methods: We performed a retrospective review of all patients who were diagnosed with AIS secondary to cardio-embolic mechanisms and were admitted to our hospital between January 1, 2018, and December 31, 2022. The inclusion criteria consisted of patients aged 18 to 100 years who were found to have intra-cardiac thrombi and were initiated on anticoagulation within 80 hours of symptom onset. Infarct volume was measured using the ABC/2 formula. Statistical analysis was conducted using the R statistical program. For variables with a normal distribution, we used the mean and standard deviation (SD), and for variables with skewed distribution, we reported the median with interquartile range (IQR).

Results: A total of 597 patient charts were reviewed for this study. After applying the inclusion criteria, 36 patients were deemed eligible for inclusion in the analysis. Among the included patients, a majority were male, constituting 80.6% (n=29) of the sample. The infarct volume among the included patients ranged from 0 ml to 100 ml. A breakdown of infarct volumes is as follows: Twenty-three patients (63.9%) had infarct volumes of 10 ml or less. Seven patients (19.4%) had infarct volumes ranging between 11 - 20 ml. Six patients (16.7%) had infarct volumes that exceeded 21 ml, with the largest infarct measuring 100 ml. There was no clinically significant HT. There were no surgical interventions required for any of our study subjects.

Conclusion: The initiation of anticoagulation within 80 hours following AIS secondary to intra-cardiac thrombi may be safe, especially in patients with infarct volumes of 20 ml or less when using the ABC/2 formula.